Procedure for Cystoscopy and Internal Urethrotomy

Urethrotomy

Urethrotomy is an outpatient procedure which involves incising urethra (a tube like structure that transports urine from the bladder to an external opening). This is done especially with the purpose of urethral stricture treatment. The other method used in urethral stricture is dilation.

Indications for Internal Urethrotomy

An urologist may indicate an internal urethrotomy in short urethral strictures (in the absence of pronounced scarring).

Internal Urethrotomy Complications

The complications of Internal Urethrotomy complications include:

• Recurrence of the stricture
• Excessive bleeding: This bleeding can be managed/stopped by inserting a properly sized catheter. The bleeding is a result of injury to corpus spongiosum or corpus cavernosum)
• There are some rare complications like:
  • Erectile dysfunction (because of trauma to erectile tissue)
  • Urinary incontinence (because of trauma to urinary sphincter)

Cystoscopy Definition

Cystoscopy is also done with this procedure, the internal lining of the urinary bladder and urethra is examined. A hollow tube known as cystoscope (which is equipped by a lens) is passed through the urethra into the bladder.

Indications for Cystoscopy

Cystoscopy procedure is indicated for evaluating and diagnosing the following conditions:

• Enlarged prostate gland (can be due to prostate cancer)
• Bladder cancer
• Any cancerous/non-cancerous growths
• Inflammation as a result of infection/injury
• Haematuria (presence of blood in urine)
• Chronic pelvic pain
• Interstitial cystitis
• Pain while urination
• Frequent UTI (Urinary tract infections)
• Urinary blockage
• Urinary incontinence

Internal Urethrotomy + Cystoscopy Procedure

• The patient is placed in the lithotomy position
• The urinary meatus is cleansed and then draped for the surgery
• Anaesthesia is administered (short term general anaesthesia) into the urethra
• A penile clamp is applied for some time and then removed before the insertion of a cystoscope.
• The cystoscope is inserted (with an injection system) and withdrawn and sufficient time is allowed for the action of the local anaesthetic
• A rigid urethrotome/cystoscope (flexible)/or their combination is inserted and guided to the face of the stricture
• A small blade towards the tip of the instrument is used to cut the stricture
• The instrument is then withdrawn
• Catheterisation is done (A Foley catheter is inserted into the urinary bladder)

Post Procedure Care

• The catheter is removed after 3 to 7 days post the surgery.
• An uro-flowmetric study is done.
• A follow-up evaluation is done usually after thirty days